EFFICACY OF ELECTRICAL MUSCLE STIMULATION IN CLINICAL PRACTICE

V.N. Obolenskiy1,2

1City Hospital #13 (Moscow, Russia), 2RNRMU (Moscow, Russia)

Disclosures

Nothing to disclose

Relevance

The thromboembolic complications occur in 1-2% of all hospitalized patients,

cause more than 10% of all deaths,

are the leading cause of death in hospitalized trauma patients.

Stein P.D. et al., Chest 2011 Jun;139(6):1317-21.

The generally accepted methods of prevention

of thromboembolic complications

Drug prevention

Compression knitwear

Early activation of the patient

Intermittent pneumocompression

Passive movements

Barrera L.M. et al., Cochrane Database Syst Rev 2013 Mar; 28;3.

HOWEVERHOWEVER!!

None of these methods does not use the most important mechanism in ensuring

normal physiological conditions, the outflow of venous blood –

the work of the muscular-venous pump the work of the muscular-venous pump of the shin .of the shin .

Methods for the prevention of thromboembolic complications

in trauma patients under external fixator or skeletal traction?

Drug prevention - yes!

Compression knitwear ??Early activation of the patient ??

Intermittent pneumocompression ??Passive movement ??

Relevance

Despite all prevention methods over the past decade in the world

rate of deep vein thrombosis increased by 3.13.1 times,

the incidence of pulmonary embolism increased by 2.52.5 times

Mokhitary M. et al., Thromb Res 2014 Apr;133(4):567-73

Electropulse Myostimulation

The most effective way of stimulating muscle pump and prevention of venous stasis

Kaplan R.E. et al., Thromb Haemost 2002 Aug; 88(2)200-4Griffin M. et al., Eur J Vasc Endovasc Surg 2010 Dec;40(6):766-71

Czyrny J.J. et al., Vascular 2010 Jan-Feb; 18(1):20-7

Electropulse Myostimulation

"Training walk" in the conditions of immobilization of the limb:

•the elimination of edema and lymphedema, •improvement of venous outflow •the increase in arterial inflow, •improvement of microcirculation, •the increase of circulating blood volume in the limb, •prevention of thromboembolic complications

Own research60 patients 40 to 85 years

Long operational manual (4.0 + 1.2 hours)

The high risk of thromboembolic complications

(2012) EMS group(n=30)

Control group(n=30)

Deep vein thrombosis of the shin without signs of pulmonary embolism

1 (3,3%)

10 (33,3%)

Thromboembolism of pulmonary artery branches 0 2 (6,7%)

р=0,008

Lobastov K., Barinov V., Laberko L., Obolensky V. et al., Int Angiol 2014 Feb;33(1):42-9.

PURPOSE OF THE STUDY

Evaluate the effectiveness of indirect electro myostimulation (EMS) in the prevention

of thromboembolic events (TE) and reduction of terms of treatment and

rehabilitation of patients with fractures of the shin bones (FSB).

V.N. Obolenskiy, A.V. Karpenko / Wound Medicine 2014;5:25-28

MATERIALS AND METHODS

A prospective randomized controlled trial

60 patients with closed fractures of the tibia (segment 4 on the classification of AO/ASIF)

Timing of the injury – 0.5 to 3.0 hours

MATERIALS AND METHODS

The treatment algorithm of all patients:

1.Stabilization of the fracture - external fixator or skeletal traction2.Assigning low molecular weight heparins3.After the relief of edema - the final reduction and fixation (intramedullary or extramedullary) under the control of image intensifier

MATERIALS AND METHODS

Research Group30 patients

(18 men, 12 women; mean age 42.4 + 1.5 years) - 2 sessions EMS, 3 hours daily from

the first day

Control group30 patients

(17 males, 13 females; mean age 44.0 + 2.2 years)

MATERIALS AND METHODS

RESULTS

EMS group n=30

Control group n=30

p

The period of relief of the edema, days 5,1 + 0,5 8,2 + 0,7 < 0,05

The period until the final osteosynthesis, days 7,3 + 0,7 10,4 + 0,9 < 0,01

The duration of hospitalization, days 16,6 + 1,0 17,7 + 1,3 0,02

The frequency of thromboembolic complications

0

2 (14,3%)

< 0,001

RESULTS

EMS group n=30

Control group n=30

p

The increase in the index of the SF-36 to the 5th day after the final osteosynthesis

24,9% 14,5% < 0,05

The increase range of motion (flexion) after the final osteosynthesis

71,9% 16,7% < 0,01

The increased range of motion (extension) after the final osteosynthesis

194,1% 10,2% < 0,002

CONCLUSIONS

Application of the methodology EMS managed to avoid thromboembolic

complications, improve the quality of life of the patients during hospital stay, reduce the

period of treatment and rehabilitation.

DISCUSSION

The use of this technology allows to quickly arrest the peripheral edema and thereby

reduce the time of the final osteosynthesis.

The muscle training in conditions of immobilization of the limb does not allow to

develop the atrophy and thereby shortens the rehabilitation period.

Study PersonnelStudy Personnel::Surgeons Surgeons - - V.N. ObolenskiyV.N. Obolenskiy1,21,2,, K.V. Lobastov2,, L.A. Laberko2, , P.S. Leval1

Trauma surgeons – A.V. Karpenko1,3, , An.A. Semenisty1,4

Nurses – Nurses – all nurses in surgery/trauma/orthopedic unitsall nurses in surgery/trauma/orthopedic units11

Department of wounds and wound infections

1City Hospital #13 (Moscow, Russia), 2RNRMU (Moscow, Russia), 3RUFP (Moscow, Russia), 41st MSMU (Moscow, Russia)

Acknowledgements

Thank you for your attention !